I stood in the hallway of the African Hotel in Tunis wearing a bathrobe and sandals unsure which way to turn. Flanked on both sides by large ornate doors encrusted with mosaics of translucent tiles artfully lettering something in Arabic, I had no idea where to go. At the front desk, using my mostly forgotten college French, I’d inquired about the spa (la source mineral) initially uncertain whether I would be directed to a steam room or rock quarry. A flurry of hand gestures by the concierge led me to the hall of the two doors. Though it seemed likely they were doors to a spa, I feared they might lead to separate facilities for men and women, or perhaps different religious groups. I imagined myself ignorantly stumbling through the wrong door breaking a cultural taboo, being thrown out into the streets, forever banished from the three-and-a-half-star, mildly comfortable hotel. So there I stood, towel in hand uncertain what to do or where to go.
Once decided, my wife and I knew we would quickly become parents. Only after several months of trying without success did our certainty wane. But we were not the sort to easily give in to failure, and when we encountered a setback we simply redoubled our efforts. Our planned family would be an appropriate testament to the efforts we were willing to endure to create it. Tests, temperature readings and ultrasounds replaced the passion in our marriage, a sacrifice we gladly made to achieve conception.
Months passed, and our efforts finally paid off with a positive pregnancy test. Sure that the most difficult part of becoming parents had been overcome, a kind of excited relief ensued. While we understood that the certainty of pregnancy within the first ten weeks is unclear, we felt the biggest barrier had been cleared. We cautiously began to tell friends and family that a child was likely on the way.
No one in Iceland should ever need to bathe in a bathtub. It is said that everyone on the small island lives within two or three kilometers of a hot spring (hver), created from melting glaciers seeping down through the volcanic soil and roiling back up after touching the earth’s mantle. While a slight sulfuric odor present in most hot springs, they are exceedingly pleasant. Many Icelandic hot springs have been turned into semi-luxurious spas. In non-Nordic countries they might have become luxurious spas, but Icelanders shares the Nordic passion for understatement, so at best the spas are merely semi-luxurious.
Many hot springs sit next to ice-covered lakes. One can often see Icelanders (and the occasional tourist) running down a long dock, steam rising from their naked skin, jumping into the frozen lake with the aplomb of a stage diving rock star. Where the tradition started is unclear, perhaps “falling into the lake” was some sort of Vikings ritual, or perhaps for Icelanders the rich warmth of the hot spring needs to be offset by the austerity of bone-chilling icy lake water.
One of the oddities about Icelanders is the widespread belief in “hidden people” (think elves, dwarves, gnomes...). A sophisticated society with one of the best educated populations on the planet, it is estimated nearly a third of the population maintain these medieval beliefs. Such magical thinking seems justified in a place where black sand beaches are bejeweled with diamonds of ice, where steam from ice touching volcanic rock shoots great boiling geysers high in the air and waterfalls spill into giant cracks in the earth. After all, there is nothing more magical than sitting in a hot spring at night beneath the aurora borealis listening to the hidden people whispering behind rocks and bushes.
There are times when it is incredibly difficult to be the partner of a pregnant woman. It isn’t the mood swings, strange appetites or nesting behaviors that pose the greatest difficulties, but rather the inability to feel connected to an unseen, abstract unborn child. The connection between mother and fetus is something that can neither be replicated nor replaced but leaves those unattached to the womb sidelined. This is not to diminish the importance of relationships that follow birth, nor to minimize the discomforts of pregnancy, but simply to point out that there is a deep bond that builds between woman and child even in the earliest phases of development that cannot be shared.
The first ultrasound during a pregnancy usually takes place at shortly after the first trimester, somewhere between weeks twelve and sixteen. For both parents it is a moment to finally visualize what has previously been largely conceptual. For a pregnant woman’s partner it is particularly powerful. As the partner has experienced no physiological changes, no morning sickness, no late-night desires to eat ice cream, no swollen ankles, the best a partner can do is empathize and imagine. The ultrasound changes all that.
Like most couples, my wife and I were excited and optimistic when we entered the ultrasound room to see our future progeny. We wanted to know everything: Would it look more like one of us? What was its biological gender? How high were its cheekbones?
The ultrasound tech was curt when she stopped the scan moments after it had started and excused herself from the room. She returned with a radiologist, a serious young woman who, without a word, picked up the ultrasound probe and reapplied it to the abdomen. The room was silent for several minutes as she scanned an area, pushed a few buttons on the ultrasound machine and scanned more. After a few moments she replaced the probe and turned to us.
“The fetus’s heart is beating too fast. Its heart is beginning to fail.”
Stunned, we didn’t respond.
In retrospect the words “its” and “fetus” had been carefully chosen. Not “his or hers.” Not personalized to allow detachment that might be necessary later. The radiologist was careful not to reveal too much detail. She merely diagnosed the problem and referred us to a perinatologist who we were to see a few hours later.
The perinatologist, a friend, was blunt. The electrical circuitry in the heart wasn’t working correctly. It might improve as the fetus grew, or might not. We could try using a medication, digoxin, to slow the heart rate, which might help. At that point all our assumptions were at an end and we found ourselves in the same vortex of uncertainty we had inhabited in the process of trying to conceive. But soldiering on had worked before and we saw no reason not to try harder. After a long, frank conversation, we left with the medication, the means to monitor the fetal heart rate and new resolve.
The most tepid water in the world runs through British faucets. Never hot enough, without enough water pressure, British baths and showers are miserable. British character, manifest in surviving Viking raids, first building then relinquishing a worldwide empire and surviving the Nazi blitz was no doubt created by keeping a stiff upper lip while showering in a British bath.
While the traditional British bath may be unpleasant, things may also be changing. A company called Aqualisa developed a shower system that provides hot showers without the need of a hot water heater, negating the culprit behind cold British baths. But Aqualisa encountered a particular quirk in British plumbing sales: the British plumber. British plumbers, it seems, didn’t particularly care whether their customers had water warm enough to melt ice, or whether there was sufficient flow from a faucet. Instead their goal was simply to finish a job, head to the pub and watch football on the tele. In what has become a favorite business school case study, Aqualisa had to figure out how to sell showers and baths without plumbers. Rather than relying on the professional class, it chose to market directly to the public and a growing cohort of DIYers. The British Home Depot crowd responded, and sales have been on the rise since.
I am reassured that improved baths in London and Leeds is satisfying for those living in or visiting Great Britain. Yet I wonder if somehow it signals a loss in British society. As Theresa May wrestles with Brexit, it seems there has been a weakening within British society. The people that defended their island from the Spanish Armada and Nazi blitzkrieg seem somehow less resilient than their history suggests. They wrestle with immigration and cede to breaking apart of long held alliances whether the EU, the Scotts or NATO. Or perhaps their showers are just getting warmer.
Two weeks after starting digoxin it was apparent the medication wasn’t working. The fetal heart rate had barely budged. In one final attempt to reverse the course of its failing heart, my wife agreed to try intravenous digoxin at very high doses. In order to maximize the amount of digoxin crossing the placental barrier, the intravenous doses would be very high; high enough to cause toxicity necessitating a need for close monitoring.
There are generally two emotions exhibited by those who enter an intensive care unit. The first is fear; fear of the vulnerability and nakedness of the patients, fear of the endless tubes extruded from every possible orifice, fear of screaming monitors beeping with every breath, fear of death. Equally palpable is a sense of control; control of breathing and circulation, control of consciousness, control over life itself. Entering a unit, it is difficult to distinguish between the two emotions, which is not surprising as fear and control are the two emotions manifest from the opposing sides of certainty.
While it wasn’t clear to me which emotion my wife carried with her as she entered the unit, I felt a sense of control. I could see the dosage of digoxin carefully titrated as her heart rate was monitored. I could see fetal movements and heart rate. I felt certain that we would see the fetal heart rate slow, its heart recover and all would be made well.
After two days of trying, the fetal heart rate didn’t slow. Control became fear. On the afternoon of the second day, the doctors addressed the situation. The perinatologist was frank about the outcome. The fetus would die, either in utero or at birth.
The Japanese bathing ritual is similar to many other traditions. The Japanese bathhouse, (onsen) require the bather to prepare by sitting on a small stool in front of a spigot and dump buckets of water over their heads in preparation to lounge about in a pool of hot water. Generally, a scrub brush is provided, and the bather makes a good show of scrubbing clean before entering the onsen pools.
Unlike swimming pools in the West, public pools in Japan are expected to remain abundantly clean. Anyone who has donned goggles and looked beneath the surface of a public pool in the United States recoils with disgust at the bits of hair and skin floating about. Though I’m not sure Japanese pools are much better, they are expected to be clean and pure.
Japan is a nation that exudes resilience. Nearly every natural and man-made disaster that could befall a people has affected Japan at some point in recent history. Within the last few generations, earthquakes, tsunamis, war and nuclear disasters have regularly afflicted the archipelago. In every case bouts of anguish and grief are followed by rebuilding and resilience. How a nation with so many scars endures is a great mystery. Onsens are a place of calm, of regeneration and regrowth. Whether they actually wash away the collective memory is unclear, but they at least allow moments of solitude in an angry world.
Many years before the pregnancy a combination of college embryology and a libertarian streak left me unequivocally favoring a woman’s right to have an abortion. I believe(d) the issue is complex enough that the decision to abort a fetus should not be left to broad platitudes or the ambivalence of government, but should be held in the confines of pregnant women and their advocates. When the doctor brought up the potential need for an abortion, I assumed I wouldn’t have an issue accepting it. Yet in that moment I hesitated. In retrospect I’m not sure why it was so difficult to accept the need to undergo removal of the fetus. I had assumed it would be harder for my wife, given the bond she had developed with the dying fetus, but instead it was I who had the greatest difficulty accepting the need for an abortion. Both my wife and the doctor suggested that I needed a bit more time to think about it “before I would be ready.” I was embarrassed, but to this day can’t explain why acceptance of the procedure was so difficult.
The abortion was scheduled a week later. I went with my wife to hold her hand, support and console her. In the end I did as much to distract myself from my own feelings of loss.
Even in the best guidebooks there is a misunderstanding about the differences between the Moroccan and Turkish baths. To be fair the baths are quite similar, comprised of a series of rooms the bather moves through as part of the bathing ritual. The bath will often begin with a shower followed by a room with dry heat, a steam room and a room with hot and cold pools of water. While it is often asserted that the order of the rooms, or a difference between dry heat and steam marks the primary difference between the two, it is not so.
In reality, the distinctive features of Moroccan and Turkish baths are far less subtle than a preference for a specific kind of heat. In the Moroccan bath (a hammam) a dark tarry exfoliant (belti) is applied generously by either by bathhouse personnel (in the posh hammams), a fellow bather, or (for those lacking money or friends) the bather. Following the administration of the exfoliant, a large irritable hairy woman scrubs off the exfoliant (along with whatever skin comes with it) using a kessa glove (imagine a glove covered with 30-grit sandpaper). In the nicer hammans argan oil is then applied (probably to heal the wounds inflicted by the kessa glove). While the Moroccan hammams uses a large irritable hairy woman to scrub one’s skin off, the Turkish bath uses an equally large irritable hairy man to massage one’s muscles such that the skin seems the only thing holding one’s bones together. The Turks don’t bother with exfoliants or gloves, nor does the masseur typically use any sort of massage oil, preferring instead to simply stretch and pound the bather in the same manner a chef might tenderize a steak.
The belief that there is a preferential reliance on steam rooms in one kind of bath (most books suggest the Turkish bath) is likely the product of Victorian adaptation rather than an indigenous preference. At the peak of the British empire, Turkish baths became both a curiosity and luxury afforded to aristocrats who, as a result of their sexually repressive society, probably found the idea of sitting around naked in a steamy environment enticing.
Whatever the differences, Moroccan and Turkish baths were created to offer the bather purity, the ability to cleanse the body before going to mosque and wiping away blemishes afflicting the soul. But purity is an illusion. No amount of bathing or scrubbing can wash away scars, no amount of prayer can wash away dark memories or thoughts of what might have been.
An abortion in the second term is called a dilation and extraction. This is in contrast to a dilation and curettage, which describes an abortion in the first term. “Extraction” is a harsh word, but probably accurate. In any case the procedure was shorter, and by my wife’s account, easier than imagined. I assume the fetus was dead by the time the procedure took place, though I don’t know that for sure.
Weeks passed, and things slowly normalized, at least on the surface. The emotion was gone from our marriage, replaced by a giant hole, a space unfilled. I found myself at one point sitting in my car at a four-way stop, alone, unable to move, lost in the recesses of my mind.
Given our circumstance, we agreed something had to change. We needed to escape, to travel far far away, remove ourselves from our current state, rebuild, to wash clean the sadness and grief from our beleaguered souls.
After several uncomfortable minutes standing awkwardly in the hotel hallway between the two doors, I randomly chose to open one of the doors. It was a choice without premonition, prediction, judgement or fear. The door easily swung open and I stepped into the brilliantly lit chamber inside.